[Urine cytology as a supplement to cystoscopy and biopsy in the control of bladder tumors]. / Urincytologi som supplement til cystoskopi og biopsi ved kontrol af blaeretumorer.

Throughout the years several investigations have either recommended or discredited exfoliative urine cytology because of high incidence of false negative or false positive results. Most authors agree that high grade bladder tumors are diagnosed with fairly high certainty (80-87%) by using exfoliative urine cytology whereas the value of urine cytology of low grade bladder tumors is uncertain. This investigation, including 200 patients who came for cystoscopic control of bladder tumors, revealed 87% accordance between cystoscopic biopsy and exfoliative urine cytology of high grade tumors while there were 47% false negative and no false positive of low grade tumors. On this background, it must be concluded that exfoliative urine cytology is an important investigation in diagnosing and controlling patients with bladder tumors, but the method can not always stand alone.

Renal acidification defects in patients with their first renal stone episode.

To rule out renal acidification defects, 40 consecutive patients with their first renal stone episode were evaluated by measurement of fasting morning urine pH levels followed by a short ammonium chloride loading test in cases with high levels. Two patients (5%) exhibited incomplete distal renal tubular acidosis, the rest had normal urinary acidification. In view of the short duration of stone disease in the patients studied, the acidification defects were considered to be primary, and the stone formation secondary. The results justify extension of these simple screening procedures for unmasking renal acidification defects to include all patients with renal stone disease.

Effect of orchidectomy on serum concentrations of testosterone and dihydrotestosterone in patients with prostatic cancer.

Because it is well known that prostatic cancer is dependent on testosterone, and that dihydrotestosterone is the active mediator of the androgen action in the prostatic cell, we studied serum concentrations of testosterone and dihydrotestosterone in 84 patients with prostatic cancer, 40 of whom were treated by orchidectomy, and 44 who were not treated. There was a significant correlation between testosterone and dihydrotestosterone concentrations in the untreated group, but no correlation among the patients treated by orchidectomy. The results indicate that the effectiveness of orchidectomy as androgen withdrawal treatment in prostatic cancer should be assessed by measurement of both dihydrotestosterone and testosterone concentrations.

Teflon injections in post-prostatectomy incontinence.

Twenty-five males with post-prostatectomy incontinence due to sphincter damage underwent transperineal or transurethral Teflon injections. The results were classified into three grades: good, moderate, and poor. Good or moderate results were obtained in 24%. No major immediate complications or longterm side-effects were observed. This intervention is associated with a minimum of discomfort for the patient and hospitalization can be limited to 48-72 hours. The results are not so good as those obtained in female incontinence, and the procedure cannot be recommended as first choice treatment in patients with post-prostatectomy incontinence, but because of the simplicity of the procedure, it is considered to be a valuable alternative in patients not suitable for prosthetic surgery.

Renal acidification defects in medullary sponge kidney.

Thirteen patients with medullary sponge kidney underwent a short ammonium chloride loading test to investigate their renal acidification capacity. All but 1 presented with a history of recurrent renal calculi and showed bilateral widespread renal medullary calcification on X-ray examination. Nine patients had some form of renal acidification defect; 8 had the distal type of renal tubular acidosis, 2 the complete and 6 the incomplete form. One patient had proximal renal tubular acidosis. These findings, which suggest that renal acidification defects play an important role in the pathogenesis of renal calculi in medullary sponge kidney, have considerable therapeutic implications.

Screening renal stone formers for distal renal tubular acidosis.

A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted; 13 had incomplete and 1 had complete distal RTA. Distal RTA was found particularly in recurrent stone formers (17%), and especially in those with bilateral stone disease, where a distal renal tubular acidification defect was found in 50%. We have been unable to differentiate primary from secondary RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use in daily clinical practice, is applied to all stone formers and not restricted to patients with recurrent stone disease.

Distal renal tubular acidosis in recurrent renal stone formers.

Renal acidification ability was examined in 90 recurrent renal stone formers, using fasting morning urinary pH levels followed by a short ammonium chloride loading test in subjects with pH levels above 6.0. Fifteen patients (16.6%) revealed a distal renal tubular acidification defect: one patient (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available, this has important therapeutic implications. The pathological sequence in renal stone formers with dRTA is discussed.